QUEENSLAND ALL BREEDS YOUNGSTOCK SHOW 2020 OFFICIAL ENTRY FORM

Please print clearly

Name of Registered Owner/s: ______________________________________________

Full Address:_____________________________________________________________

P: ___________ M: _______________ Email: ___________________________________

Nominations are pre-entry or on the day including Futurities. There is NO penalty for on-the-day entries. You MUST also submit photocopies of your current membership & registration certificate for EACH breed/colour you are entering PLUS a signed waiver form & Health Declaration with your entriesPRE-ENTRIES ARE PREFERRED – can be emailed or posted.PRE-ENTRIES IN HARD COPY MUST BE POSTMARKED BY 6th September 2020 AT THE LATESTIF COPIES OF REGISTRATIONS AND MEMBERSHIPS ARE NOT ATTACHED TO ENTRIES, THEY WILL BE RETURNED.

ADMINISTRATION FEE $15NON-MEMBER SHOWING LEVY $15 per personPLEASE ENSURE 1 FORM PER PERSON IS COMPLETED– more avail. at Nom. Box

___ people @ $15 each $____

BRIDLE NUMBERS - $10 refunded when number is returned ___ horses @ $10 each $____

STABLE: $10 per stable per day – __ stables x ___ days $____

STABLE CLEANING FEE $25 per stable per day – must be cleaned completely __ stables x ___ days $____

CAMPING SITE FEE $25 per night @ $25 per night $_____

TOTAL OF ENTRIES FROM SECOND PAGE $_____

SPONSORSHIP $_____

TOTAL FEES $______

Cheques/money orders payable to: Dilutes Australia Ltd Qld BranchBanking details for EFT payment – Bendigo Bank – BSB 633 000 – Acct# 123 342 529 – Acct name Dilutes Australia Qld Branch – Reference is your surname & Y’stock

I hereby apply to enter the events indicated above. I have read the Conditions of Entry and agree to abide by them at all times. I am a financial member of all Breed Societies listed above. I hereby release Dilutes Australia Ltd and the Queensland Branch from any claim, accident, injury or loss that may occur to any person (competitor or spectator), property or livestock during the course of the show.

Signature: __________________________________ Date:___________________

Entries to: Jan Sheehan, All Breeds Youngstock Show: 254 Old Ropeley Rd, Ropeley Q 4343 or doralmirpark@gmail.com

Page 2 2020 Qld All Breeds Youngstock Show HORSE ENTRIES FOR (OWNER’S NAME)_________________________________________

1. Name of Horse/Pony Date of BirthBreed Society Reg’n #Breed Society Reg’n #Breed Society Reg’n #

Class Numbers 1st class ____ (not a Futurity class)

No.____________________________________________________________

$14 first class $14

__ Classes @ $8 $____

DILUTE FUTURITY D1 D2 D3 D4 - Please circle @ $15 $____OPEN FUTURITY O1 O2 O3 O4 – Please circle @ $30 $_____

2. Name of Horse/Pony Date of BirthBreed Society Reg’n #Breed Society Reg’n #Breed Society Reg’n #

Class Numbers 1st class ____ (not a Futurity class)

Nos.___________________________________________________________

$14 first class $14

__ Classes @ $8 $____

DILUTE FUTURITY D1 D2 D3 D4 - Please circle @ $15 $____OPEN FUTURITY O1 O2 O3 O4 – Please circle @ $30

$_____

3. Name of Horse/Pony Date of BirthBreed Society Reg’n #Breed Society Reg’n #Breed Society Reg’n #

Class Numbers 1st class ____ (not a Futurity class)

Nos.___________________________________________________________

$14 first class $14

__ Classes @ $8 $____

DILUTE FUTURITY D1 D2 D3 D4 - Please circle @ $15 $____OPEN FUTURITY O1 O2 O3 O4 – Please circle @ $30

$_____

4. Name of Horse/Pony Date of BirthBreed Society Reg’n #Breed Society Reg’n #Breed Society Reg’n #

Class Numbers 1st class ____ (not a Futurity class)

Nos.___________________________________________________________

$14 first class $14

__ Classes @ $8 $____

DILUTE FUTURITY D1 D2 D3 D4 - Please circle @ $15 $____2

OPEN FUTURITY O1 O2 O3 O4 – Please circle @ $30 $_____

Total this page (to be transferred to first page) $____

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Horse Health Declaration BIOSECURITY INFORMATION Competitors MUST complete Pre-Movement Biosecurity Declaration (see below). This form MUST be handed into the Office. These will be recorded against entries- No form no ride!!!!!!

EVENT Name: QLD ALL BREEDS YOUNGSTOCK SHOW 2020

Declaration by owner or person in charge of horse/s I, declare that the horse/s named above has / have been in good health, eating normally and not shown signs of illness during the last 3 days leading up to the above mentioned event . I give my authorisation for the designated Steward to call for veterinary inspection of the horse/s named above and in my care should they be showing signs of illness at any time during the course of the event. I agree to pay any veterinary fees incurred as a result of this. I AGREE TO ENSURE THAT:

1. If required before movement, all horses will be shampooed, rinsed and allowed to dry, and their hooves are picked clean of all solid material and washed with shampoo.

2. All vehicles and equipment accompanying the horses should be in a clean condition at the start of travel to the above mentions event.

3. The information contained in this Horse Health Declaration is true and correct to the best of my knowledge. 4. I agree to abide by all conditions and directions of the EQ rules and regulations and Event organisers. 5. I acknowledge that failure to comply with the above may result in refusal of entry to the venue, disqualification

or other disciplinary action as decided by DA Judiciary / Disputes Committee. 6. In the event of horse movement restrictions, each participant will be responsible for the care, maintenance and

cost of their horse including feeding and watering.

__________________________ ___________________________ _________________________ Name Signature Date

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